Cities have elevated temperatures compared to rural areas, a phenomenon known as the “urban heat island”. Higher temperatures increase the risk of heat-related mortality, which will be exacerbated by climate change.

Objectives

To examine the impact of climate change and urban growth on future urban temperatures and the potential for increased heat stress on urban residents.

Methods

We conducted a systematic review of scientific articles from Jan 2000 to May 2016.

Results

The majority (n = 49, = 86%) of studies examined climate change and the urban heat island in isolation, with few (8) considering their combined effect. Urban growth was found to have a large impact on local temperatures, in some cases by up to 5 °C in North-east USA. In some locations climate change increased the heat island, such as Chicago and Beijing, and in others decreased it, such as Paris and Brussels. When the relative impact of both factors was considered, the temperature increase associated with the urban heat island was always higher. Few studies (9) considered heat stress and its consequences for urban populations. Important contributors to urban temperatures, such as variation in urban density and anthropogenic heat release, were often excluded from studies.

Conclusions

We identify a need for an increased research focus on (1) urban growth impact on the urban heat island in climate change studies; (2) heat stress; and, (3) variation in urban density and its impacts on anthropogenic heat. Focussing on only one factor, climate change or urban growth, risks underestimating future urban temperatures and hampering adaptation.

Healthy Cities of Tomorrow: the Case for Large Scale Built Environment-Health Studies.

EXCERPT FROM INTRODUCTION: New scientific evidence generated over the past decade points to a significant role played by a myriad of attributes of our cities’ built environments (BE) in shaping human behaviour, health and well-being [3, 4, 5, 6]. This has resulted in a renaissance of interest in an environmentalmodel of public health, comprising interventions specific to physical and social environments [7, 8]. We view this as similar to the wave of public health interest that gave birth to modern town planning in the mid to late twentieth century. Non-clinical environmental interventions in the form of health-specific planning and design of neighbourhoods and cities have been scientifically shown to have significant potential in playing a role in creating healthy cities of tomorrow. In addition to enabling healthier lifestyles, such interventions can produce higher cost effectiveness ratios in health service provision and can thus play a part in reducing future health expenditures [9]. The creation of healthy cities will entail a much closer integration and synergy between the disciplines of public health, epidemiology, transport planning, urban planning and design.

In the recent years several ongoing projects have emerged that aim specifically to measure health-specific components of urban environments at a large scale. The ultimate objective is to eventually link them with existing health cohorts enabling interdisciplinary collaborations and evidence generation towards creation of healthy cities. The Place, Health and Liveability project is one such national-level study aiming to create neighbourhood-level spatial measures of urban liveability across seven domains of employment, food, housing, public open space, social infrastructure, transport and walkability in Australia [10]. Algorithms measuring weighted street distance of individual dwellings to amenities and public transit have been developed to produce composite Walk Scores and Transit Scores in most US cities and some Canadian and Australian cities at the level of individual properties [11]. These are being linked with existing health cohorts to decipher associations with individual’s active travel behaviours [12]. Furthermore, there are many large scale health studies being conducted around the world, including the UK Biobank study (described in the subsequent section), 45 and Up Study in New South Wales, Australia1 (N = 250,000 participants); EpiHealth Study, Sweden2 (N = 300,000); China Kadoorie Biobank, China3 (N = 500,000); Million Death Study, India4 (N = 1,000,000) and Hong Kong FAMILY Cohort5 (N = 46,000) to name just a few. These present us (BE and urban planners and designers, epidemiologists, health economists, public health researchers and policy makers) with a well-timed opportunity to join expertise and resources for an integrated and multi-disciplinary global consortium to model and create national-level BE-health databases that can be turned into fine-tuned professional decision support and guidance systems. In the remaining part of this paper, we shall discuss some of the key issues and challenges in creation of healthy cities and ways to overcome them through interdisciplinary evidence generation on a large scale, planning and forecasting.

A Difference-in-Differences Approach to Assess the Effect of a Heat Action Plan on Heat-Related Mortality, and Differences in Effectiveness According to Sex, Age, and Socioeconomic Status (Montreal, Quebec)

Background: The impact of heat waves on mortality and health inequalities is well documented. Very few studies have assessed the effectiveness of heat action plans (HAPs) on health, and none has used quasi-experimental methods to estimate causal effects of such programs.

Objectives: We developed a quasi-experimental method to estimate the causal effects associated with HAPs that allows the identification of heterogeneity across subpopulations, and to apply this method specifically to the case of the Montreal (Quebec, Canada) HAP.

Methods: A difference-in-differences approach was undertaken using Montreal death registry data for the summers of 2000–2007 to assess the effectiveness of the Montreal HAP, implemented in 2004, on mortality. To study equity in the effect of HAP implementation, we assessed whether the program effects were heterogeneous across sex (male vs. female), age (≥ 65 years vs. < 65 years), and neighborhood education levels (first vs. third tertile). We conducted sensitivity analyses to assess the validity of the estimated causal effect of the HAP program.

Results: We found evidence that the HAP contributed to reducing mortality on hot days, and that the mortality reduction attributable to the program was greater for elderly people and people living in low-education neighborhoods.

Conclusion: These findings show promise for programs aimed at reducing the impact of extreme temperatures and health inequities. We propose a new quasi-experimental approach that can be easily applied to evaluate the impact of any program or intervention triggered when daily thresholds are reached.

Findings from published studies suggest that exposure to and interactions with green spaces are associated with improved psychological wellbeing and have cognitive, physiological, and social benefits, but few studies have examined their potential effect on the risk of mortality. We therefore undertook a national study in Canada to examine associations between urban greenness and cause-specific mortality.

Methods

We used data from a large cohort study (the 2001 Canadian Census Health and Environment Cohort [2001 CanCHEC]), which consisted of approximately 1·3 million adult (aged ≥19 years), non-immigrant, urban Canadians in 30 cities who responded to the mandatory 2001 Statistics Canada long-form census. The cohort has been linked by Statistics Canada to the Canadian mortality database and to annual income tax filings through 2011. We measured greenness with images from the moderate-resolution imaging spectroradiometer from NASA’s Aqua satellite. We assigned estimates of exposure to greenness derived from remotely sensed Normalized Difference Vegetation Index (NDVI) within both 250 m and 500 m of participants’ residences for each year during 11 years of follow-up (between 2001 and 2011). We used Cox proportional hazards models to estimate associations between residential greenness (as a continuous variable) and mortality. We estimated hazard ratios (HRs) and corresponding 95% CIs per IQR (0·15) increase in NDVI adjusted for personal (eg, education and income) and contextual covariates, including exposures to fine particulate matter, ozone, and nitrogen dioxide. We also considered effect modification by selected personal covariates (age, sex, household income adequacy quintiles, highest level of education, and marital status).

Findings

Our cohort consisted of approximately 1 265 000 individuals at baseline who contributed 11 523 770 person-years. We showed significant decreased risks of mortality in the range of 8–12% from all causes of death examined with increased greenness around participants’ residence. In the fully adjusted analyses, the risk was significantly decreased for all causes of death (non-accidental HR 0·915, 95% CI 0·905–0·924; cardiovascular plus diabetes 0·911, 0·895–0·928; cardiovascular 0·911, 0·894–0·928; ischaemic heart disease 0·904, 0·882–0·927; cerebrovascular 0·942, 0·902–0·983; and respiratory 0·899, 0·869–0·930). Greenness associations were more protective among men than women (HR 0·880, 95% CI 0·868–0·893 vs 0·955, 0·941–0·969), and among individuals with higher incomes (highest quintile 0·812, 0·791–0·834 vs lowest quintile 0·991, 0·972–1·011) and more education (degree or more 0·816, 0·791–0·842 vs did not complete high school 0·964, 0·950–0·978).

Interpretation

Increased amounts of residential greenness were associated with reduced risks of dying from several common causes of death among urban Canadians. We identified evidence of inequalities, both in terms of exposures to greenness and mortality risks, by personal socioeconomic status among individuals living in generally similar environments, and with reasonably similar access to health care and other social services. The findings support the development of policies related to creating greener and healthier cities.

Proximity and access to water have long been central to human culture and accordingly deliver countless societal benefits. Over 200 million people live on Europe’s coastline, and aquatic environments are the top recreational destination in the region. In terms of public health, interactions with ‘blue space’ (eg, coasts, rivers, lakes) are often considered solely in terms of risk (eg, drowning, microbial pollution). Exposure to blue space can, however, promote health and well-being and prevent disease, although underlying mechanisms are poorly understood.

AIMS AND METHODS:

The BlueHealth project aims to understand the relationships between exposure to blue space and health and well-being, to map and quantify the public health impacts of changes to both natural blue spaces and associated urban infrastructure in Europe, and to provide evidence-based information to policymakers on how to maximise health benefits associated with interventions in and around aquatic environments. To achieve these aims, an evidence base will be created through systematic reviews, analyses of secondary data sets and analyses of new data collected through a bespoke international survey and a wide range of community-level interventions. We will also explore how to deliver the benefits associated with blue spaces to those without direct access through the use of virtual reality. Scenarios will be developed that allow the evaluation of health impacts in plausible future societal contexts and changing environments. BlueHealth will develop key inputs into policymaking and land/water-use planning towards more salutogenic and sustainable uses of blue space, particularly in urban areas.

ETHICS AND DISSEMINATION:

Throughout the BlueHealth project, ethics review and approval are obtained for all relevant aspects of the study by the local ethics committees prior to any work being initiated and an ethics expert has been appointed to the project advisory board. So far, ethical approval has been obtained for the BlueHealth International Survey and for community-level interventions taking place in Spain, Italy and the UK. Engagement of stakeholders, including the public, involves citizens in many aspects of the project. Results of all individual studies within the BlueHealth project will be published with open access. After full anonymisation and application of any measures necessary to prevent disclosure, data generated in the project will be deposited into open data repositories of the partner institutions, in line with a formal data management plan. Other knowledge and tools developed in the project will be made available via the project website (www.bluehealth2020.eu). Project results will ultimately provide key inputs to planning and policy relating to blue space, further stimulating the integration of environmental and health considerations into decision-making, such that blue infrastructure is developed across Europe with both public health and the environment in mind.

Association of Long-Term Exposure to Transportation Noise and Traffic-Related Air Pollution with the Incidence of Diabetes: A Prospective Cohort Study.

Evidence for an association between transportation noise and cardiovascular disease has increased; however, few studies have examined metabolic outcomes such as diabetes or accounted for environmental coexposures such as air pollution, greenness, or walkability.

OBJECTIVES:

Because diabetes prevalence is increasing and may be on the causal pathway between noise and cardiovascular disease, we examined the influence of long-term residential transportation noise exposure and traffic-related air pollution on the incidence of diabetes using a population-based cohort in British Columbia, Canada.

Transportation noise was associated with the incidence of diabetes [interquartile range (IQR) increase, 6.8 A-weighted decibels (dBA); OR=1.08 (95% CI: 1.05, 1.10)]. This association remained after adjustment for environmental coexposures including traffic-related air pollutants, greenness, and neighborhood walkability. After adjustment for coexposure to noise, traffic-related air pollutants were not associated with the incidence of diabetes, whereas greenness was protective.

CONCLUSION:

We found a positive association between residential transportation noise and diabetes, adding to the growing body of evidence that noise pollution exposure may be independently linked to metabolic health and should be considered when developing public health interventions.

Hear the latest results based on an analysis of the Canadian Census Health and Environment Cohort, from Dr. Dan Crouse and Adele Balram, University of New Brunswick.

Dan L Crouse is a Research Associate in the Department of Sociology at UNB. He is trained in both epidemiology and geography, and has led and been involved in many studies examining the impacts of exposure to air pollution on adverse health outcomes, including risk of mortality, adverse birth outcomes, and incidence of cancer. He lead the first Canadian Census Health and Environment Cohort (CanCHEC) study to examine associations between mortality and long-term exposures to fine particulate matter, which was published in 2012, and has published several other studies with CanCHEC since then.

Adele Balram is a Database Analyst with the New Brunswick Institute for Research, Data, and Training. She holds a Bachelor of Science degree in Biology from the University of New Brunswick and a Master of Public Health from Memorial University in Newfoundland. Adele has several years’ experience in public health, including working as an epidemiologist on environmental and community health issues across New Brunswick.

Both Dr. Crouse and Ms. Balram are supported by the Maritime SPOR Support Unit (MSSU), which receives financial support from the Canadian Institutes of Health Research (CIHR), the Nova Scotia Department of Health and Wellness, the New Brunswick Department of Health, the Nova Scotia Health Research Foundation (NSHRF), and the New Brunswick Health Research Foundation (NBHRF).

http://canue.ca/wp-content/uploads/2016/07/CANUE-logo-final-300-291x300.png00Eleanor Settonhttp://canue.ca/wp-content/uploads/2016/07/CANUE-logo-final-300-291x300.pngEleanor Setton2017-09-29 02:53:582017-10-17 15:36:53Does Living in Greener Areas and Near Water Affect Mortality? | VIDEO NOW AVAILABLE

Emerging studies have implicated air pollution in the neurodegenerative processes. Less is known about the influence of air pollution, especially at the relatively low levels, on developing dementia. We conducted a population-based cohort study in Ontario, Canada, where the concentrations of pollutants are among the lowest in the world, to assess whether air pollution exposure is associated with incident dementia.

METHODS:

The study population comprised all Ontario residents who, on 1 April 2001, were 55-85years old, Canadian-born, and free of physician-diagnosed dementia (~2.1 million individuals). Follow-up extended until 2013. We used population-based health administrative databases with a validated algorithm to ascertain incident diagnosis of dementia as well as prevalent cases. Using satellite observations, land-use regression model, and an optimal interpolation method, we derived long-term average exposure to fine particulate matter (≤2.5μm in diameter) (PM2.5), nitrogen dioxide (NO2), and ozone (O3), respectively at the subjects’ historical residences based on a population-based registry. We used multilevel spatial random-effects Cox proportional hazards models, adjusting for individual and contextual factors, such as diabetes, brain injury, and neighborhood income. We conducted various sensitivity analyses, such as lagging exposure up to 10years and considering a negative control outcome for which no (or weaker) association with air pollution is expected.

RESULTS:

We identified 257,816 incident cases of dementia in 2001-2013. We found a positive association between PM2.5 and dementia incidence, with a hazard ratio (HR) of 1.04 (95% confidence interval (CI): 1.03-1.05) for every interquartile-range increase in exposure to PM2.5. Similarly, NO2 was associated with increased incidence of dementia (HR=1.10; 95% CI: 1.08-1.12). No association was found for O3. These associations were robust to all sensitivity analyses examined. These estimates translate to 6.1% of dementia cases (or 15,813 cases) attributable to PM2.5 and NO2, based on the observed distribution of exposure relative to the lowest quartile in concentrations in this cohort.

DISCUSSION:

In this large cohort, exposure to air pollution, even at the relative low levels, was associated with higher dementia incidence.

Background: PM2.5 precursor emissions have declined over the course of several decades, following the implementation of local, state, and federal air quality policies. Estimating the corresponding change in population exposure and PM2.5-attributable risk of death prior to the year 2000 is made difficult by the lack of PM2.5 monitoring data.

Objectives: We used a new technique to estimate historical PM2.5 concentrations, and estimated the effects of changes in PM2.5 population exposures on mortality in adults (age ≥30 y), and on life expectancy at birth, in the contiguous United States during 1980–2010.

Methods: We estimated annual mean county-level PM2.5 concentrations in 1980, 1990, 2000, and 2010 using universal kriging incorporating geographic variables. County-level death rates and national life tables for each year were obtained from the U.S. Census and Centers for Disease Control and Prevention. We used log-linear and nonlinear concentration–response coefficients from previous studies to estimate changes in the numbers of deaths and in life years and life expectancy at birth, attributable to changes in PM2.5.

Results: Between 1980 and 2010, population-weighted PM2.5 exposures fell by about half, and the estimated number of excess deaths declined by about a third. The States of California, Virginia, New Jersey, and Georgia had some of the largest estimated reductions in PM2.5-attributable deaths. Relative to a counterfactual population with exposures held constant at 1980 levels, we estimated that people born in 2050 would experience an ∼1-y increase in life expectancy at birth, and that there would be a cumulative gain of 4.4 million life years among adults ≥30 y of age.

Conclusions: Our estimates suggest that declines in PM2.5 exposures between 1980 and 2010 have benefitted public health.